oral Qs Flashcards
(24 cards)
Low risk for suicide
I’m going to assess for risk, seeing if they have ideation, means and plans. If the risk is low, I’m going to:
Create a safety plan
Possible increase # of sessions
Activate their support system
Offer daily phone check ins
Provide a suicide hotline #
Consider a psychiatric evaluation to see if medication can help
High risk for suicide
If the risk is deemed high, I’m going to:
Encourage the client to voluntarily admit themselves to a hospital for treatment
If they refuse, I would initiate a Welfare and Institutions Code Section 5150 and have them involuntarily admitted for a 72 treatment hold.
I would alert their support system
I would have them get a psychiatric evaluation to see if medication is needed
Throughout this process, I would:
Document everything in writing
Seek guidance from my supervisor
From here, we’re going to create a Treatment Plan
Homicide - crisis
Within this vignette, the client said ____ and also behaved in a manner in which they may be a possible danger to others. So I’ll need to assess the level of risk and threat.
If I conclude that the threat is real, then:
This would be a mandated breach of confidentiality.
If I suspect a possible Tarasoff situation, I would assess for:
Imminent danger
Identifiable victims
If the criteria are met, I would:
Call the police
Warn the intended victim (Duty to Warn)
I could also hospitalize the client (voluntarily or involuntarily/5150)
Consult with a supervisor
Increase the frequency of therapy sessions
Refer to groups, anger management
Abuse - crisis
Based on the vignette, I’m going to assess for possible cases of abuse
If I suspect child abuse (18 and younger), I will:
Make a verbal report to CPS immediately and submit a written report within 36 hours
Next ensure the safety of the child: create a safety plan, identify safe caregivers, and give child strategies to use if they feel unsafe
Establish a treatment plan focused on ending the pattern of abuse
If I suspect elder abuse (which is 60+) or dependent adult abuse (19-59) whether physical, sexual, neglect, abandonment, isolation or fiduciary, I will:
Report asap to Adult Protective Services or police
Follow up in writing
If I suspect domestic violence, I will:
Create a safety and crisis plan
Give safety #’s, DV shelters and programs
Conduct individual sessions
Alcohol & Drugs
Based on the vignette, I would assess for possible alcohol or drug abuse. If suspected, I would:
Hospitalize them, if warranted, voluntarily
Contract them to come to session with 24 hours of sobriety
Psychoeducation on impacts of SU
Refer client to detox, outpatient treatment, or 12 step program
Create a treatment plan to support their recovery
Eating disorders
Provide immediate safety from least to most invasive, such as:
-Assess for possible eating disorder
voluntary enrollment in a treatment program.
-If necessary, initiate involuntary hospitalization if the client was in imminent danger
-medical evaluation by an MD
-refer the client to a qualified eating disorder specialist.
Legal - fees
I am legally obligated to clearly disclose my fees to clients before services are rendered, and I would obtain informed consent from clients regarding my fees.
Legal - RK
I am legally obligated to keep records of treatment to track progress & results. I must keep all records under two locks.
For adults, records are kept for 7 years after treatment
For minors they are kept 7 years after they turn 18.
Legal - ROI
I must have my client sign, which would allow me to engage in any exchange of information with adjunctive services I may refer them to. Include what information & expiration date
Legal - Suicidality
I am legally obligated to confidentiality and to communicate to my client that while we do have therapist/client confidentiality that I am also a mandated reporter. I would be permitted to breach confidentiality if I determine suicidality, and I would take the steps mentioned in the crisis section of the exam.
Legal - Scope of practice
I will assess if the case falls within my scope of practice as a MFT trainee. This is defined by the legal regulations governing my profession. It outlines the range of services I am qualified to provide, including assessment, diagnosis, treatment, and interventions, and the types of clients I can effectively work with. I believe this client falls within my scope of practice.
Legal - Telehealth
As a therapist in California providing telehealth services, my key legal obligations include obtaining informed consent from the client, informing them of risks and limitations, and documenting efforts to ascertain relevant emergency resources in their area. I must also ensure that my practices adhere to confidentiality and security protocols. Confirm address and location.
Legal - Consent to treat minor
For minors (under 12), I would determine who has the legal authority to consent to their treatment and get those signatures. Legal consent can either be signed by the parent/s or by another family member through a caregiver authorization affidavit. This family member must be living with the child, but the therapist does not have to ask for proof or validate this claim. The minor can also consent to their own treatment starting at age 12, as long as they can understand what therapy is and what they are consenting to. Other legal authorities can also consent on a minor’s behalf such as CPS, the court, a social worker, probation officer, etc.
Legal - Mandated breaches
Tarasoff Duty to Protect: When a client communicates a “serious threat of physical violence against a reasonably identifiable victim or victims,” the therapist has a legal duty to protect the potential victim(s). This mandates the therapist to take action, which may include disclosing information to the intended victim(s) and/or law enforcement.
Child Abuse Reporting: California law mandates therapists (and other professionals) to report any known or suspected instances of child abuse or neglect to the appropriate authorities (e.g., Child Protective Services).
Elder/Dependent Adult Abuse Reporting: Similar to child abuse, California law mandates therapists to report known or suspected abuse of elderly or dependent adults.
Court Orders: If a court issues a valid court order for the release of client information, the therapist is mandated to comply.
Legal - Permitted breaches
I am permitted to breach confidentiality, but not mandated to, in the following situations―
Suicidality
Danger to others / property
Emotional abuse of child
Ethical - Informed consent
I am ethically obligated to obtain Informed Consent from my clients, which means they have a clear understanding of what therapy is, what my services include such as any specialties or specific theoretical orientation
Ethical - Office policies
I am ethically obligated to articulate my office policies, such as my cancellation policy, when payments are due, and communication preferences, vacation policies, no-shows, insurance.
Ethical - Management of fees
I have an ethical obligation to be clear and transparent about fees, to make my fees reasonable and to consider my rates in relation to my clients’ financial situations, and to provide accurate and timely billing.
Ethical - Gift giving
I would be explicit about my policies concerning gift giving and receiving.
Ethical - Referrals / Scope of Competence
I must offer referrals to another professional if treatment is outside of my scope of competence, which is defined by my level of training and education, and my specialities and expertise.
Ethical - No secrets
I have an ethical responsibility to articulate my No Secrets policy. My policy is to not keep secrets for any of my clients.
Ethical - Diversity / Cultural competency
I am ethically obliged to provide culturally sensitive and appropriate care to all clients, to make every attempt to understand and respect the cultural values, beliefs, customs, worldviews, and practices of your clients, to be aware of system oppression, discrimination and social inequities, to recognize my limitations, and seek training when appropriate.
Ethical - Dual relationships
I must be ethically aware of dual relationships to avoid conflict of interests and preserve the confidentiality of my clients.
Ethical - Countertransference
I am ethically obligated to try to be aware of how my own history and biases are impacting my perceptions and reactions to my clients. It is my duty to manage my countertransference. If it becomes problematic, I have a responsibility to seek supervision or refer out.
